| Payment ID | 15458 |
|---|---|
| Date Created | 01/12/23 11:58 am |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 14906 |
| Authorization Number | |
| Applicant Information | |
| Name | Alyssa Lewis |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170601130 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $989.64 |
| Receipt Amount | $989.64 |
| Receipt Date | 01/11/2023 |
| Comments | hotel stay at Motel 6 departure date is 01/26/23 |
| Receipt | 11-01-2023Lewis989.64.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/12/2023 |
